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Job Details

UnitedHealth Group

Clinic Case Manager - Albuquerque, NM




Albuquerque, New Mexico, United States

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

The Clinic Case Manager is responsible for fostering collaboration and a team approach for successfully supporting patients with high-risk health conditions to navigate the healthcare system. Promotes empowerment by facilitating the role of an educator, resource, and advocate for patients and their families to ensure a maximum quality of life. Interacts and collaborates with multidisciplinary care teams, to include physicians, nurses, pharmacists, case managers, social workers, and other educators. Acts as a clinic resource for the value-based population. Works in a less structured, self-directed environment and performs all delegated nursing duties within the scope of a RN license of the applicable state board of nursing.

Ensures compliance to contractual and service standards as identified by relevant health insurance plans. Adheres to policies, procedures, and regulations to ensure compliance and patient safety. Participation in Compliance and required training is a condition of employment.

Primary Responsibilities:

  • Role embedded within the primary care clinic, working directly with patients, clinical and non-clinical teams
  • Participates in the identification of a focused clinic patient panel, as defined by the manager of Medical Management
  • Supports longitudinal care of the patient with chronic care conditions:
    • Communicates with patients, responding to patient questions via patient portal and other modalities
    • Performs assessment of health conditions and implements care plan in collaboration with the member, caregiver(s), clinician(s), and/or other appropriate healthcare professionals to address need and goals
    • Pursues appropriate interventions to reduce risk of condition exacerbation, ER and hospitalization utilization
    • Performs medication reconciliation and collaborates with clinician partner as needed
    • Conducts Motivational Interviewing and Self-Management Goal setting
    • Provides patient education
    • Creates referrals to appropriate agencies and resources
  • Supports transition of care from Emergency Department or inpatient stay to outpatient setting:
    • Performs assessment of transitional needs
    • Performs medication reconciliation
    • Establishes and reviews contingency plan
    • Provides patient education
    • Assists with post discharge needs such as home health care, prescriptions, transportation, Durable Medical Equipment (DME), appointments
  • Coordinates with providers to establish or update individualized plan of care
  • Creates referrals to appropriate internal and external resources
  • Achieves Quality Measures outcomes via reduction in HEDIS Gaps in Care
  • Performs accurate and timely documentation in the electronic medical record
  • Performs triage and clinical tasks within their scope of practice
  • Participates in daily huddles and monthly clinic meetings, as required
  • Prepares accurate and timely reports, as required
  • Maintains continued competence in nursing practice and knowledge of current evidence-based practices
  • Performs ongoing updates of the care plan to evaluate effectiveness, and to document interventions and goal achievement
  • Maintains a working knowledge of community resources
  • Serves as facilitator and resource for other members of the Medical Group clinical team
  • Attends departmental meetings and provides constructive recommendations for process improvement
  • Performs other duties as assigned

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Associate degree in nursing
  • Valid NM RN License or valid multi-state compact license
  • Current BLS Certification
  • Must be 21 years or older and have a valid NM State Driver’s license
  • 3+ years of previous job-related experience in a healthcare environment
  • Knowledge of medical terminology
  • Skilled with MS Office software applications
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

  • Bachelor’s degree or higher in healthcare related field
  • 2+ years of experience providing prior authorization or case management within health plan or integrated system
  • Excellent communication, interpersonal, organization and customer service skills
  • Self-motivated, strong computer skills
  • Attention to detail
  • Ability to multi-task and work under pressure

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.